A Week Devoted to Wellness in the Preclinical Phase: Lessons Learned

Background During the 2017-2018 academic year, a large private medical college underwent a complete transformation of its curriculum from a primarily lecture based, traditional format to an integrated, longitudinal format that included both time limited blocks and longitudinal threads of content. Wellness, conceptualized at both wellness of the provider and the patient, is one of the eight threads. Goals Provide a structured pause in medical school for you to reflect on your own wellness Allow time to explore the ideas of resilience Provide time for rejuvenation Allow you to start building productive habits to last you throughout your entire medical careershttps://jdc.jefferson.edu/rmposters/1005/thumbnail.jp

Distributions based Regression Techniques for Compositional Data

A systematic study of regression methods for compositional data, which are unique and rare are explored in this thesis. We start with the basic machine learning concept of regression. We use regression equations to solve a classification problem. With partial least squares discriminant analysis (PLS-DA), we follow regression algorithms and solve classification problems, like spam filtering and intrusion detection. After getting the basic understanding of how regression works, we move on to more complex algorithms of distributions based regression. We explore the uni-dimensional case of distributions, applied to regression, the beta-regression. This gives us an understanding of how, when the data to be predicted, or the outcome, is assumed to be of beta distribution, a prediction can be made with regression equations. To further enhance our understanding, we look into Dirichlet distribution, which is for a multi-dimensional case. Unlike traditional regression, here we are predicting a compositional outcome. Two novel regression approaches based on distributions are proposed for compositional data, namely generalized Dirichlet regression and Beta-Liouville regression. They are extensions of Beta regression in a multi-dimensional scenario, similar to Dirichlet regression. The models are learned by maximum likelihood estimation algorithm using Newton-Raphson approach. The performance comparison between the proposed models and other popular solutions is given and both synthetic and real data sets extracted from challenging applications such as market share analysis using Google-Trends and occupancy estimation in smart buildings are evaluated to show the merits of the proposed approaches. Our work will act as a tool for product based companies to estimate how their investments in advertising have yielded results in the market shares. Google-Trends gives an estimate of the popularity of a company, which reflects the effect of advertisements. This thesis bridges the gap between open source data from Google-Trends and market shares

GEOMETRY AND SIZE OF SUBSTRATE TOPOGRAPHY GUIDES THE NEURAL DIFFERENTIATION OF HUMAN EMBRYONIC STEM CELLS

Ph.DDOCTOR OF PHILOSOPH

Rehabilitation of a Patient with Diabetic Myonecrosis: A Case Report

Setting: Inpatient rehabilitation unit at a university hospital Patient: 37-year-old male with diabetic myonecrosis. Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping. Assessment/Results: Upon initial consultation, he ambulated 25-50 feet at a minimum assistance level with a single point cane. As he was unsafe to return home alone, he was transferred to inpatient rehabilitation after a two week acute hospitalization. During his rehabilitation stay, he increasingly was unable to tolerate standing secondary to pain, and at discharge, he was non-ambulatory despite many attempts at pain control and assistive devices for ambulation. His right leg swelling persisted throughout his stay. After five weeks on our unit, he was discharged to a long-term care facility at a wheelchair independent level. One year later he still was not ambulating, and still lived in the long-term care facility. Discussion: Diabetic myonecrosis is an uncommon complication of both insulin-dependent and non-insulin dependent diabetics. Symptoms usually resolve on their own with rest and analgesics within weeks to several months. There are reports of physical therapy prolonging the recovery period and exacerbating symptoms, which may have happened with our patient. Conclusions: Download poster

Inclusivity in Action: Interprofessional Curricula Integrates Two-Step Question for Sex and Gender Identity

Background: Identifcation of sex and gender identity is the first step to inclusive care for sex and gender minorities, and studies have shown that health care providers may make heteronormative assumptions about sex and gender. Implemented in 2007, the Jefferson Health Mentors Program (JHMP) involves firstand second-year students from couple and family therapy, human genetics and genetic counseling, medical laboratory sciences, medicine, nursing, occupational therapy, pharmacy, physical therapy, and physician assistant studies. In the First assignment, 140 student teams complete a comprehensive questionnaire, the Individual Life and Wellness History with their Health Mentor. Health Mentors live with one or more chronic conditions and range in age from 27 to 95 years old, with the majority over age 50. Interprofessional education where students learn from, with, and about each other is an ideal place for students to be exposed to the sex and gender two-step question. Objectives: To describe our experience with 713 students involved in the JHMP asking the two-step sex and gender question. Methods/Research: In Fall 2018, the two-step sex and gender question was added to the questionnaire. The module evaluation included both a quantitative and a qualitative question to gather student feedback on the inclusion of the two-step sex and gender questions. The qualitative responses were reviewed for themes, and the authors came to consensus. Conclusions/Impact: Common themes included student appreciation of the importance of the questions; confusion of the Health Mentors with the questions; student perception of generational differences, and student teams having no issues with the questions. No Health Mentors dropped out of the program after the First assignment, other than those who dropped out for health related reasons. Interprofessional education can provide a venue for normalizing the two-step sex and gender question.https://jdc.jefferson.edu/sexandgenderhealth/1000/thumbnail.jp

Utilization of Dantrolene in Stiff-Person Syndrome: A Case Report

Setting: University hospital-based acute rehabilitation. Patient: 75-year-old woman with Stiff-Person Syndrome (SPS) with a recent fall and Colles fracture. Case Description: Four months prior to admission, the patient was diagnosed with SPS, negative for anti-GAD antibodies. Diagnosis was based on a 3-year history of progressive rigidity leading to frequent falls and fractures. Anxiety and fear of falling limited her mobility, and she sustained a sacral pressure ulcer during acute hospitalization. On admission, history was remarkable for unsteady gait and muscle cramps exacerbated when startled or excited. Examination was remarkable for rigidity in her axial and limb muscles. She presented at the maximal assist level for transfers and toileting and moderate assist level for grooming and ambulation using a platform walker (right arm in cast). She was unable to tolerate titration of diazepam due to sedation, or baclofen due to hypotension. Results: During acute rehabilitation, rigidity was treated with titration of dantrolene (from 25 to 50 mg four times daily) in addition to maximal tolerated doses of diazepam (1 mg qAM/2 mg qPM) and baclofen (20mg TID). The addition of dantrolene reduced rigidity and improved range of motion, both subjectively per patient and objectively by exam. Functional gains stalled with dose decrease and resumed with dose increase. She had pronounced gains in grooming to the supervision level, modest gains in transfers and toileting to the moderate assist level, but remained at the moderate assist level for ambulation. Progress was limited due to a change to non-weight bearing status of her right arm. Anxiety and depression were improved with buspirone, paroxetine, and psychological counseling. Discussion: SPS results in significant activity of daily life and ambulatory dysfunction as exemplified by her pressure ulcer and multiple falls. Although GABA agonists are the preferred treatment for SPS, the adverse effects of high doses can increase the risk of falls. Dantrolene reduced muscle rigidity and improved function without sedative or hypotensive effects. Conclusion: Dantrolene is a useful additional treatment for SPS rigidity

CBL Facilitation: A Survey of Facilitators and Students with a Particular Interests in Team Building and Facilitation Improvement

Purpose: As the CBL cases have become more refined, there is a desire to continually improve the way cases are being facilitated, understand the methods that are working well, learn if there are practices that are detrimental to learning, and better understand how students are transitioning to teams. This project gathered information from both the from the Class of 2023 during their first year in the SKMC program and their CBL facilitators in order to improve the CBL facilitation. With the information gathered, there were two aims. First, to generate suggestions which were discussed at the CBL facilitators’ back to school meeting. Second, to work towards improvements in the first CBL transition during Wellness Week. Methods: The data was collected in the form of an IRB exempt survey via GoogleForms. The survey links were emailed to the Phase 1, Year 1 CBL students and their Phase 1, Year 1 CBL facilitators twice (5/11/2020 and 5/19/2020). Responses were collected, complied, and sent to Dr. Truong and Dr. Ankam prior to the faculty and curricular development meetings for the 2020-2021 academic year. The target learners were SKMC students with particular emphasis on Year 1 students. Results and Conclusions: When asked to rate CBL experience overall, responses from both students and facilitators were positive. Students expressed a desire for there to be changes made to the Wellness Week programming and results were mixed when asked if a structured teambuilding activity would be a good addition to CBL. Both Dr. Truong and Dr. Ankam expressed that the feedback collected from the surveying was useful and implemented in their planning for the 2020-2021 academic year. Future surveying could seek to collect data on whether students and their CBL facilitators feel that there has been improvement made in the delivery of CBL and Wellness Week

The Role of Critical Case Analysis in Interprofessional Education

Goals for interprofessional education include preparing students to work in collaborative practice, teaching them how to work in teams and to asses and improve the quality of patient care. (Barr, 2007, Thibault, 2013). Four core competency domains have been established to inform interprofessional education (Interprofessional Education Collaborative Expert Panel, 2011). These are ethics/values, roles/responsibilities, interprofessional communication and teams/teamwork. Various pedagogical approaches have been used to help students meet these competencies. The Josiah Macy, Jr. Foundation (2013) recommends development and implementation of innovative models to link interprofessional education and practice. Thibault (2013) recommends students engage in “real work” as part of their interprofessional education experience